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Medical and legal ethics. Theoretical and legal substantiation of the principles and its place in the system of social regulation of the sphere of medical activity
Revealing the peculiarities of the correlation of ethical principles and rules with the rule of law, a combination of legal and ethical levels of regulation of the sphere of medical activity, it is advisable to dwell on highlighting the development prospects of medical and legal ethics - a new complex interdisciplinary branch of knowledge.
Domestic legal and medical scientific literature contains conflicting information regarding what should be understood as medical legal ethics and what problems it should deal with. The author suggests the term medical legal ethics to understand the following.
Medical and legal ethics is a set of ethical principles and norms that have already been reflected or are at the stage of introduction into the regulatory framework of legislation regulating public relations in the field of public health.
This branch of knowledge should be considered as an integral part of the general system of social regulation of the sphere of medical activity, in which the medical ethics and deontology are the basic level of regulation, and the following are bioethics and medical and legal ethics. The top of the pyramid of social regulation of the field of medical activity is medical law.
According to A.A. Glasheva, “the issue of consolidating ethical principles for doctors has long been discussed both among medical scientists and among legal scientists in our country” * (55). In other words, the task of combining ethical principles and legal norms is more relevant than ever for lawyers and medical professionals. The need to regulate medical activities based on the principles of medical ethics is connected with a number of circumstances, the main sign of which are the increased requirements for specialists engaged in medical activities. This applies, inter alia, to the assimilation by medical workers of the basic principles of medical legal ethics and the norms of medical law, both in the process of primary professional training and in the process of continuing postgraduate education.
As a discipline that allows comprehensive coverage of these problems within the curriculum of medical schools, medical and legal ethics should be presented. Currently, the aspects of social regulation of the healthcare sector that are to be studied from the standpoint of medical and legal ethics are considered in the literature unilaterally, as a rule, within the framework of medical ethics or in the course of the basics of legal knowledge. The current state of affairs indicates the lack of sufficient knowledge of medical ethics among practitioners and scientists in the field of medicine and jurisprudence. The consequences of this state of affairs, unfortunately, are disappointing: medical workers who do not know their rights and duties, who do not represent the boundaries of their authority, beyond which criminal, civil or administrative liability sets in, cannot be considered a qualified specialist and pose a certain threat to life and health patients.
As an example, the authors of the textbook on medical ethics can be cited. "A code of laws has been developed in medicine that dictates to the practitioner what he can and cannot do: but some professionals are worried about the letter of the law and whether they will be convicted of a crime for committing what they consider correct in accordance with ethical considerations "* (56).
The authors of the textbook actually contrast the principles of medical ethics, deontology, and legal norms, which does not correspond to the main provisions of medical and legal ethics, which seeks to combine the ethical principles of medical activity with the norms of medical law. In this regard, when licensing medical activities, along with other criteria for assessing the professional preparedness of medical workers for practical activities, it is necessary to recognize the need to assess knowledge of the main provisions of medical and legal ethics.
According to the definition of the World Health Organization, "a doctor is a person who, having been admitted in the prescribed manner to a medical school, duly recognized in the country in which it is located, has successfully completed the prescribed course of medical sciences and received a qualification that gives a legal right to medical practice ... "* (57). Of particular note in this definition is the provision on the “legal right” to engage in medical activities. In this regard, it seems necessary to increase the requirements for knowledge of the fundamentals of medical legal ethics and medical law for all, without exception, medical professionals.
The subject of the study of medical and legal ethics should be considered problems that require knowledge of ethical and legal norms. According to the authors of the guidelines on medical ethics and medical deontology: “Ethics and human rights are closely intertwined: here is respect for the patient’s freedom and conscious decision, the right to choose a doctor and consent to give him the freedom to determine the treatment method within his competence, which makes sense voluntary consent, allowing a certain alternative, as well as respect for human life and dignity, respect for the right to non-interference in private life and to professional secrecy "* (58). In the citation, only a certain part of the problems that are within the competence of medical and legal ethics is indicated.
Taking into account that medical legal ethics is the third (after medical ethics and bioethics) level of social regulation of the sphere of medical activity, it is advisable to dwell on the coverage of the position that the industry occupies in the general structure of social regulation of medical activity and those issues that are the subject of study of medical ethics.
First of all, it is necessary to point out that throughout the history of the development of medicine there have been disputes as to which problems of regulation of the sphere of medical activity are inherent in medical and legal ethics: moral or legal. It should be agreed with S.S. Shevchuk, who claims that “for a long time, the development of medical science and practice came into contact with the law only slightly. Traditionally, it turned out that in medicine preference was given to moral standards and medical ethics” * (59).
Among medical workers, now and earlier, it is widely believed that their profession is more akin to art than to craft. Therefore, when they talk about responsibility for certain offenses, then most often doctors refer to conscience, censure from colleagues, moral and ethical responsibility. This, apparently, can explain the results of a sociological study conducted among doctors.
"At present, Russia's health care is characterized by a contradiction when legal norms are ahead of the preparedness of the public consciousness for them" * (60). This situation cannot be considered optimal, since the implementation of the norms of the current legislation is possible only when the law is not divorced from the principles of morality, morality, and ethics developed over the centuries.
The validity of considering medical legal ethics as one of the levels of regulation of medicine is explained by many circumstances, the main of which are:
- insufficiency of the provisions of deontology and bioethics in the system of social regulation of various aspects of the medical care process;
- knowledge of the basic principles of medical and legal ethics will improve the legal culture, legal literacy of medical workers;
- medical and legal ethics - a means of preliminary ethical examination of bills in the field of healthcare;
- legal training of medical workers will be more successful provided that knowledge of basic ethical and moral principles is combined with the provisions of medical and legal ethics;
- medical and legal ethics is one of the means of public control over the observance of the rights and legitimacy of protecting the legitimate interests of citizens in the provision of medical care;
- The norms of medical and legal ethics are an important component of crime prevention among medical professionals.
Consider the circumstances listed in more detail.
The insufficiency of the standards of deontology and bioethics to solve some problems of medical care is most evident in the application of new biomedical technologies. A. Lozovsky and A. Tikhomirov believe that in the field of medical activity "a separate problem is the distinction between the spaces of legal and ethical regulation" * (61). In this regard, taking into account the interdisciplinary and complex nature of medical and legal ethics, it should be recognized as a kind of connecting link between the indicated levels of social regulation of the sphere of medical activity.
G.A. Yushmanova rightly notes that "bioethics, in its essence, is a system of knowledge about the boundaries within which the manipulation of the natural has been allowed. And here the dual - moral - legal nature of the regulation of medical activity is very important * * (62). It is the solution to these problems that seems to be dealt with by medical legal ethics. In addition, at present, the ideas about the essence of many social processes and phenomena have slightly changed. “Traditionally, the social component of medical knowledge was represented by professional ethics. In the context of modern culture, it is supplemented by medical law” * (63).
Thus, many researchers state that a number of problematic issues cannot be resolved within the framework of traditional medical deontology and bioethics. This is one of the essential reasons for the necessity and justification for the emergence of medical ethics as a branch of knowledge that deals with the border issues of ethics and morality in medicine, which are partly reflected in regulatory documents.
The main tasks of medical ethics are:
- Creation of a moral and ethical basis for bills in the healthcare sector;
- increasing the professionalism of medical workers, which includes an appropriate level of knowledge of moral and ethical principles, which are reflected in the regulatory framework governing medical activities.
For Russia, along with the connection with the norms of international law, a closer connection of law and morality is characteristic * (64). The last 15-20 years in the history of Russia, the organic relationship between biomedical ethics and medical and legal ethics in the legislative process has been quite clearly traced. Biomedical ethics defines the boundaries within which a legislative process is under way to protect fundamental human and civil rights.
Medical and legal ethics fills the bill, firstly, with morality and morality, and secondly, contributes to the development of optimal language for the provisions of the created legal act, taking into account social, cultural, ethical and medical national traditions. The authors of the manual on philosophy and biomedical ethics are absolutely right, claiming that "any legislative act is progressive, useful if it is moral, that is, the law adequately meets the stringent requirements of achieving good and good for a person, protecting his rights, freedoms, honor and dignity "* (65).
Practically those legal documents that do not have a moral, cultural and moral foundation, as a rule, are hardly realizable in life. Often, for this reason, many of these laws do not apply. At the same time, “historical experience indicates that it is extremely dangerous to instill morality by force” * (66). In these conditions, the practical importance of medical and legal ethics in the legislative process becomes apparent.
The position of Yu.P. Lisitsyna, who claims that "there is no" iron "wall between the moral, ethical rules that are developed and regulated by society, and the legal, legal norms regulated by law, by the state ..." * (67). Taking this into account, it is the norms of medical and legal ethics that can become a kind of connecting link between moral principles and legal norms.
It is for this reason that the author proposes medical and legal ethics as one of the means of increasing legal literacy and legal culture of medical workers. If a medical professional is not limited in his activities to the mechanical performance of official duties, if he has a desire to comprehend the adequacy, morality and legality of his actions, then obtaining knowledge of medical and legal ethics will become an urgent need for such a specialist and will testify to his high qualification and sufficient training.
One of the priority tasks of the reform of domestic health care is justifiably considered to be overcoming the complexity of the situation in which legal norms are created in conditions of the moral unpreparedness of medical workers * (68). The importance of this provision is not in doubt.
Thus, it seems quite reasonable opinion about the need to position medical legal ethics as an independent interdisciplinary branch of knowledge and one of the levels of the social regulation system in the field of medical activity. It is important that the existing health problems "are opposed to moral and humane legislation that promotes the exercise of the rights and protection of the legitimate interests of patients in the provision of medical care" * (69), one of the conditions of which is the sufficient development of medical and legal ethics.
In such a situation, it seems quite realistic to create adequate conditions for the quality assimilation by medical workers of ethical, moral principles and legal norms governing their professional activities, which, ultimately, will play a positive role, as for medical workers themselves who need to protect professional honor and dignity , and for patients, in turn, who need full protection of their rights to life and health when contacting health workers in the hope of receiving oevremennoy, effective and adequate medical care.
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